Vital Statistics Form

Please fill this form out as much as possible. It will help us to complete the death certificate and in writing the obituary. All fields with an asterisk are required.

Deceased's Information

If residence, please include address
mm/dd/yyyy
English, Irish, French, German, etc.
Be specific
Primary occupation during working years. *Do not enter \"retired\".
Sales, Medical, Engineering, Construction, etc.
Please list survivors and relationship: son, daughter, brother, sister, etc.
Religious affiliations, fraternal and civic organizations, hobbies, etc.

Informant's Information

A copy of what is submitted will be sent to this email.
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Obituaries & Condolences

Neil Alan Lewis

Charles Edward Coppedge II

Mark F. Peters

Gail Luther May

Maurice E. “Pete” Burch

Betty Congour Caywood Bushman

Nancy Schmalbeck

Josephine Frances Dauber Schulte

Phillip Eugene Larson Sr.

Gonzalo Medina Arriens

Dinah May Hall Medina

Debbie Lou Mallory